ISLAMABAD - A big chunk of 23.15 per cent of the Prime Minister’s National Health Insurance Programme’s funds is being spent on the operational and Central Management Information System (CMIS), official documents revealed this.

In the revised PC-I, the total cost of the project was reduced by one billion from Rs9.1 billion to Rs8.1 billion but the operational/management cost was enhanced from Rs353.7 million to Rs1151.25 million, revealed by the official documents available with The Nation.“Out of Rs8.1 billion of the total cost of Prime Minister’s National Health Insurance Programme project, around Rs1.875 billion or 23.15 per cent are going to be spent on Central Management Information System (CMIS), Project Management Units (PMU) and advertisement/awareness, the document revealed.

If the project is using BISP data and State life is taking care of the patients then what is the need of spending a huge portion of funds on the administrative cost, the Planning Commission questioned.

The project envisages Prime Minister’s National Health Insurance Programme to improve the health status of the population in the country by ensuring access to quality healthcare especially enhancing coverage and access to secondary and priority treatments of the poor and vulnerable population. The project is sponsored by the Ministry of National Health Services Regulation & Coordination (NHSRC) while the federal, provincial and regional PMUs and State Life Insurance Corporation are the implementing agencies.

According to the original PC-I, the total cost of the project was Rs9.1 billion but in the revised PC-I it was reduced to Rs8.17 billion but interestingly in the revised PC-I, the operational/PMU cost of the project have been increased by 22.6 per cent from Rs353.7 million to Rs1151.25 million.

The total operational cost for 03 years as per original PC-l was Rs353.70 million which has been increased to Rs1151.25 million. Huge set-up of a Federal PMU proposed in the PC-l for procurement of vehicles, equipment, furniture and their maintenance including repair, POL etc.

The Prime Minister’s National Health Insurance Programme was originally covering 23 districts but during the first year it covered only 3 districts and, ironically, now it has been extended to 34 districts. An expenditure of Rs225.00 million has been made on the project till 30 June, 2016.

The total cost of the project in the original PC-I was Rs9.1 billion but in the revised PC-I it was reduced to Rs8.1 billion. However, the operational/ administrative cost of the project gone up from Rs353 million to Rs1875 million, the documents revealed. The Planning Commission questioned that in Original PC-I, the cost of the Central Management Information System (CMIS) was only Rs88 million which has now abruptly increased to Rs669 million.

According the PC-I of the project in the original PC-I there was no cost for the Programme launch ceremonies for awareness which has now been increased to Rs161 million. Contingency cost has increased from Rs60,000 to Rs80 million, TA/ DA cost from Rs0.5 million to Rs78 million, Procurement cost from Rs7 million to Rs35 million and HR cost from Rs106 million to Rs564 million.

In original PC-I 23 Districts, 4 from each province and 2 from each region FATA, AJK, GB and ICT, with 501,048 - potential families for Secondary Treatment and 3,100,00-potential families for priority Treatment.

Initially 13 gazetted officers on MP pay scales and 35 non-gazetted staff on Basic Pay Scales were approved but now the sponsor of the project  is demanding 31 gazetted officers and 88 non-gazetted staff for the project.

Other cost of the project was also increased from Rs118.225 million to Rs900.77 million.

In its comment, the Planning Commission has questioned higher pay packages for HR personnel and normal pay for the project lower staff. It also questioned that since the project would be mainly executed by the insurance company from arrival of the patient till discharge through its empanelled hospitals, therefore, the staff should be limited.

The total cost of the project is Rs8.179 billion for a period of 03 years (Phase-I) and it shall cover around 4.65 million families in 34 districts. In PSDP 2016-17 Rs2000 million have been allocated for the project.

A premium of Rs999.99 per family (07 members) per annum has been awarded to State Life Insurance for secondary care with addition of Rs299.99 per family per annum for priority treatment. The insurance cover would be limited to Rs50,000 per family per annum for secondary care treatment and Rs250,000 per family per annum for priority treatment. 

It was also recommended by the Planning Commission that a committee shall be constituted under Secretary (Health), Member of PD&R, Finance Division, Establishment Division and concerned department for the recruitment of staff.

The Planning Ministry proposed that it is a mega project therefore a pilot scheme may be initiated in the selected districts and major part of the project be prepared, thereafter, by using learning curve advantage of cost schedule, scope etc.

According the Planning Commission, the provincial governments and Benazir Income Support Program have already launched health insurance schemes, therefore, there is a possibility of duplication of activities as the beneficiaries of this project would be the same as of provincial insurance schemes and Benazir Income Support Program.

The commission recommended that the sponsors may evolve a plan to avoid duplication of any project activity.

It was also suggested that the proposed districts where public sector hospitals including DHQ, THQ, RHCs and BHUs are already established may be strengthened and mechanism may be developed to finance poor patients’ medicines and other requirements by pooling up all the resources such as Zakat, donations, etc under a coordinated welfare office established in each hospital on the pattern of PAEC hospitals.

Responding to the Planning Commission’s comments regarding reduction in the total cost of the project, the Ministry of National Health Services Regulation & Coordination (NHSRC) said that the premium per family was reduced from Rs2500 per family per year to Rs1300 per  family per year, therefore the total cost of the project was reduced. The NHSRC has also justified the increased operational/Management cost. According the ministry, the success of the programme depends on continuous monitoring and trouble shouting at service delivery areas to the programme beneficiaries for efficient utilisation of public sector exchequer and increase awareness of beneficiaries regarding the services to be provided through health card by formally inaugurating the programme at district level.

On hiring of 85 officials for the project, the Ministry said that Human Resources are added in hierarchy of PMNHP for three purposes; to enhance the impact of the programme by monitoring service delivery at district level, to develop the internal capacity of the program to manage huge volume of data which is generated in the program on daily basis and to incorporate research findings in the future progress and expansion of the programme.

In response to high pay scales to the federal and regional PMUs, the Ministry of National responded that the programme has proposed its own PMNHP pay scales and will be implemented with the concurrence of Finance Division.

Regarding the awareness campaign, the ministry responded that the funds will be utilised for the frequent publication of supplement in all focused districts to create awareness among the beneficiary families on services offered by health card, broadcast advertisement regarding this program on TV & Radio Channels as per need and requirement, city branding including printing of steamers, banners, brochures, flyers any such material for the said purpose and on meetings/workshops/seminars/ held at district/tehsil level for awareness of beneficiaries.